Update 4/13 at 2 p.m.: DC Health expects that vaccine providers in the District will adhere to federal authorities’ recommendation to pause the use of the Johnson & Johnson vaccine. In a press conference Tuesday afternoon, DC Health director Dr. LaQuandra Nesbitt said she’s not aware of any local vaccinator that is continuing to administer the one-dose shot.
Her agency learned of the federal recommendation for a pause this morning and quickly communicated with local lawmakers, including the mayor and Council, and vaccine providers. “This pause means that the system is working properly,” said Nesbitt. “The system has allowed the CDC and FDA to act out of an abundance of caution and to provide health care providers and public health officials with the information needed to identify, treat and report this rare syndrome.”
Nesbitt is not aware of any D.C. resident or worker having the very rare but serious blood clotting problems that led federal authorities to recommend a pause in use of the J&J vaccine. Nor is Nesbitt aware of any concerning level of no-shows for vaccine appointments scheduled for Tuesday. She encouraged residents to continue to get the Pfizer and Moderna vaccines.
There will be some interruptions to DC Health’s vaccination efforts. The interruption is not much because DC Health relies more on the Pfizer and Moderna vaccines whose manufacturers, unlike J&J, provide a weekly, steady supply. In addition to canceling appointments for just over 1,000 people who pre-registered on vaccinate.dc.gov, the agency is delaying its initiative to inoculate homebound individuals. The agency is optimistic that they could use the Moderna vaccine for people experiencing homelessness or staying in DC Jail, Nesbitt said when asked about other initiatives. She added that her agency cannot replace the shipment for vaccinators who receive direct supply from the federal government, broadly speaking.
Grubb’s Care Pharmacy, who receives doses directly from the federal government, canceled appointments for the J&J vaccine on Tuesday. While Nesbitt said independent pharmacies should use vaccinate.dc.gov for appointment purposes, Grubb’s Care Pharmacy owner Dr. Michael Kim says the CDC provided him guidance that says all pharmacies in the Federal Retail Pharmacy Program are able to use their own schedulers.
“I have notified all of our appointments that their appointments have been canceled for now and will be rescheduled once we have more information about the J&J Vaccine or when we get one of the other vaccines in,” says Kim via email. “I have also encouraged everyone to continue looking for alternative vaccination sites.”
Mayor Muriel Bowser’s administration is following the recommendation of federal authorities and calling for a pause in the use of Johnson & Johnson’s single-dose coronavirus vaccine at D.C. sites. On Tuesday, DC Health sent cancelation emails to at least 1,200 individuals who were scheduled to get the J&J vaccine, according to a spokesperson for the mayor.
The Centers for Disease Control and Prevention and the Food and Drug Administration jointly called for a pause in use of the J&J vaccine while investigating six cases of a rare but serious type of blood clot within two weeks of receiving the J&J vaccine. The pause is out of an abundance of caution. There were six reports out of nearly 7 million people who have received the J&J vaccine.
“We’re recommending this pause while we work together to fully understand these events and also so we can get information out to health care providers and vaccine recipients,” said acting FDA Commissioner Janet Woodcock during a Tuesday morning press conference. “Right now, I’d like to stress these events appear to be extremely rare. However, COVID-19 vaccine safety is a top priority for the federal government, and we take all reports of adverse events following vaccination very seriously.”
All six cases involved women between the ages of 18 and 48. One woman died, and a second has been hospitalized in serious condition. Woodcock said there are too few cases to single out a particular group at risk. “We may be hearing about more cases. We will look further into this. We’ll have deliberations,” she added.
Dr. Anne Schuchat, the principal deputy director of the CDC, said the risk for individuals who have gotten the J&J vaccine more than a month ago is “very low.” “For people who recently got the vaccine within the last couple of weeks, they should be aware to look for any symptoms,” said Schuchat at the presser. “If you received the vaccine and developed severe headaches, abdominal pain, leg pain or shortness of breath, you should contact your health care provider and seek medical treatment. Now, these symptoms are different from mild flu-like symptoms—fever and so forth—that many people have experienced in a couple of days after this event.”
Dr. Peter Marks, the director of the Food and Drug Administration’s Center for Biologics Evaluation and Research, said that they have not seen similar cases of the blood clot called cerebral venous sinus thrombosis (CVST) combined with low levels of blood platelets (thrombocytopenia) in the Moderna or Pfizer vaccines. As of April 12, more than 180 million shots of the Moderna and Pfizer vaccine have been administered in the U.S., as compared to more than 6.8 million shots of the J&J vaccine.
“We have real world evidence now of the vaccine’s effectiveness in the U.S.,” said Schuchat. “So we’re taking this pause and precautions around the J&J product in the context of a large, robust, and highly safe and effective vaccination effort.” She encouraged individuals who are scheduled to get the Moderna or Pfizer vaccines to keep their appointments.
Woodcock expects the pause to last a “matter of days.” The CDC’s independent group of experts called the Advisory Committee on Immunization Practices will be meeting on Wednesday to review the data on cases related to clotting.
Meanwhile, DC Health sent an email to people who were scheduled to get the J&J vaccine this week in a District site, informing them of the agency’s decision to heed the federal recommendation. “DC Health has informed all of our vaccine providers to temporarily discontinue the use of Johnson & Johnson until the CDC and FDA can meet to discuss further,” the email says. “All appointments scheduled to utilize Johnson & Johnson between April 13 and 17 have been cancelled.” DC Health will send notifications to individuals who received this email starting tomorrow evening, so they can book another appointment for later this week or next. (Individuals are encouraged to check their spam folder.)
DC Health has told pharmacies and community health centers who participate in federal partnerships and receive doses directly from the Biden administration to stop using the J&J vaccine. CVS pharmacies in D.C. are immediately pausing the use of the J&J vaccine but continue to offer the Moderna and Pfizer vaccines. “Due to this pause, we are emailing all customers who have a scheduled appointment to receive a Johnson & Johnson COVID-19 vaccine at CVS Pharmacy to inform them that their appointment is being cancelled. We regret any inconvenience and will follow up with affected customers to reschedule their appointments as soon as possible,” a corporate spokesperson said via email.
Health departments in Maryland and Virginia are also directing vaccine providers in their respective states to stop using the J&J vaccine until an investigation is completed and new federal guidance is issued. The spokesperson for Maryland Gov. Larry Hogan tweeted that the mass vaccination site in Hagerstown, Maryland, will switch to Pfizer in order to honor all appointments on Tuesday. He also said the site can accommodate walk-ins. The second doses for this site will be scheduled for May 4.
Some are concerned that the pause is an overaction. Some also worry that this all could make more people hesitant about getting the COVID-19 vaccine. In an attempt to address this sentiment, Schuchat said: “We are committed to safety and transparency and to expeditiously learning as much as we can so that further steps can be taken. When we saw this pattern and were aware that treatment needed to be individualized for this condition, it was the utmost important for us to get the word out. That said, the pandemic is quite severe and cases are increasing in a lot of places and vaccinations are critical. So we want to make sure that we make some recommendations quickly.” The pause will enable doctors to get accurate information on how to treat the rare disorder involving blood clots, federal officials emphasized.
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